electoral verification program

electoral verification program
electoral verification program

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Form 6-Register as a New Elector/Voter. Form 6A-Register as Overseas Elector/Voter. Form 6B-Information of Aadhaar Number by Existing Electors

ELECTION COMMISSION OF INDIA
FORM-6A Acknowledgement No.____________
(See Rule-8B of Registration of Electors Rules, 1960) (To be filled by office)
Application for Inclusion of Name in Electoral Roll by an Overseas Elector
PASTE ONE RECENT
PASSPORT SIZE
PHOTOGRAPH (3.5 CM X 3.5
CM) SHOWING FRONTAL
VIEW OF FULL FACE WITHIN
THIS BOX
To, The Electoral Registration Officer, …………………………………………………………Assembly / Parliamentary Constituency
I request that my name may be included in the electoral roll for the Constituency in which my place of
the residence is located as mentioned in (j) below:
(a) Name *
(b)Last Name*
(c) Name of relative* Father Mother Husband Wife Other
(d)Last Name of relative*
(e) Date of Birth (dd/mm/yyyy)
(f)Place of Birth Village/Town
District
State
(g) Gender(Put a cross mark in proper box) Male Female Third Gender
(h) Email id#
(i) Mobile No.#
(j)Address in India as
mentioned in the original passport
House
No.
Street/Area/Locality
Town/Village
District Pin Code
(k)Details of current Passport Place of Issue
Passport No. Date of
expiry(dd/mm/yyyy)
Date of issue(dd/mm/yyyy)
(l) Details of Visa of the Country of current
residence
Visa Number
Date of issue Date of expiry
Type of Visa Name of issuing Authority
* To be filled in capital letters only
# Optional
Note:- Copies of the relevant pages of the passport containing the particulars mentioned at items (a) to (l) and current valid visa
endorsement mentioned above to be enclosed – duly self-attested if sent by post and produced with the original passport if
presented in person before the registration officer
2. (a) Reason of being absent
from the place of ordinary
residence in India.
Employment Education Other(give
Description)
(b) Date from which absenting from an ordinary residence in India(dd/mm/yyyy)
3. Full current Address in the country outside India where residing- House No.
Street/Area/Locality
Town/Village
State Country
Zip code
DECLARATION – I hereby declare that to the best of my knowledge and belief –
a. all information given in this application is true.
b. I am a citizen of India by birth/domicile/naturalization.
c. I have not acquired citizenship of any other country.
d. But for being absent from the place of my ordinary residence in India owing to the reason given in 2(a) above, I would
have been ordinarily resident at the address given in my Indian Passport, which has been reproduced at 1(j) above.
e. I undertake to immediately inform the Electoral Registration Officer through the Indian Mission in the Country of my
current residence if I renounce my Indian Citizenship or if I acquire citizenship of any other country.
f. I undertake to immediately inform the Electoral Registration Officer through the Indian Mission in the country of my
current residence of any change in my residential address in the country of my residence for the records of the Electoral
Registration Officer. I understand that any notice sent to me at the address, which is my residential address in the
country of my current residence according to the records of the Electoral Registration Officer, shall be considered due
service of notice to me under the Representation of the People Act, 1950 and the rules made there under, and that it is
my responsibility to keep the Electoral Registration Officer informed of my latest residential address in the country of my
current residence.
g. If I return to India and become ordinarily resident in India, I shall immediately inform the Electoral Registration Officer
of the concerned Assembly/Parliamentary Constituency.
h.I have not applied for the inclusion of my name in the electoral roll of any other constituency.
i. My name has not already been included in this or any other constituency Or My name may have been included in the
electoral roll of ………………………. Constituency in…………………. State in which I was ordinarily resident earlier at the address
mentioned below and if so, I request that the same may be deleted from that electoral roll, or transposed, as may be
appropriate. Full address (earlier place of ordinary residence) ………………………………………………… ……… ………… …………
………… ……………………………………………….. Elector Photo Identity Card (if issued) Number .. ……… ……… ……. …………………
date of issue…………………. …………………………………………
j. I have not been issued an EPIC in India/ have been issued an EPIC which is enclosed with this application for
cancellation.
[Note – Any person who makes a statement or declaration which is false and which he either knows or believes to be
false or does not believe to be true, is punishable under Section 31 of the Representation of the People Act, 1950 (43 of
1950).]
Place…………………………………
Date……………………………………. Signature………………………………………..
Details of action taken
(To be filled by Electoral Registration Officer of the constituency)
Application received on ………………………………………………………………………………………………………………….. (DD/MM/YYYY)
The application in Form 6A of Shri/Shrimati/Kumari …………………….………………………………………………………………….has
been:- (a) Accepted and the name has been registered in the electoral roll of …………………………….………….(constituency)
at S.No…..……………………Part No………………………
(b) Rejected for the reason:-
Date:_________________ Name/Signature of ERO/AERO
Acknowledgment/Receipt
Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Received the application for inclusion in name of self from Shri / Smt. / Ms. ________________ ____________________
[ Applicant can refer the Acknowledgement No. to check the status of application]
Name/Signature of ERO/AERO

 

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